Iranian Journal of Public Health
Year:2015 | Volume:44 | Issue:2|Papers Count:23

Background: Several studies have been conducted in China in order to investigate the potential predictors of serofast state after treatment among syphilitic patients. However, there is a remarkable diversity among the results. This meta-analysis was conducted to assess potential predictors of serofast among syphilitic patients in China.Methods: International and national electronic databases were searched up to September 2013. Reference lists of re-trieved articles were also reviewed. Cohort or case-control studies addressing risk factors of serofast among syphilitic patients were included in this study.Results: We assessed 27 separate studies involving overall 6682 HIV-negative participants with syphilis of which 1962 remained in the serofast state. The serofast was positively associated with older age (Ptrend=0.001), female (summary risk ratio [sRR]=1.50, 95%CI: 1.34-1.68), latent syphilis (sRRlatent vs primary=3.17, 95%CI: 2.66-3.77; sRRlatent vs secondary=2.00, 95%CI: 1.48-2.69) as well as non-penicillin treatment (sRR=2.99, 95%CI: 2.45-3.67), but negatively associated with higher baseline titers (sRR>1: 32 vs ≤1: 32=0.63, 95%CI: 0.54-0.75). Compared with healthy group and serological cure group, respectively, the levels of CD4 (+), IL-2, and IL-6 among serofast patients were decreased (standardized mean difference [SMD]<0, P<0.05), but the levels of CD8 (+) and IL-10 were increased (SMD>0, P<0.05). Some studies also hinted the serofast was associated with subtypes i of treponema pallidum (TP) repeat gene (RR i vs d=4.67, 95%CI: 1.31-16.69) and TP occult infection.Conclusion: The age, gender, stage of infection, baseline titers, treatment drug, cellular immune suppression and dis-orders, TP occult infection and subtypes i of TP repeat gene should be considered as important predictors of serofast. However, until now the definition and mechanism of serofast has still been not clear.

Background: In this study, we investigated the causes behind increase trends in smoking and extent of tobacco use in Saudi Arabia. We also explored the issues related to and its impact tobacco control research and policy in the King-dom.Methods: Data were collected from various published articles, public data based such as WHO, Geneva and CDC Atlanta. Data were also obtained from surveys conducted by various institutions under The Global Youth Tobacco Survey (GYTS) for high school students and Global Adult Tobacco Survey (GATS) for medical student. Tobacco importation data and death rates were estimated by various International Organizations.Results: Tobacco importation in Saudi Arabia increased from 1996 to 2012. The proportion of smokers in the KSA almost doubled especially in males from 21% in 1996 to 37% in 2012. Mortality attributable to tobacco in the KSA was estimated to account for 280, 000 premature deaths over the same period (without accounting for smuggled tobacco). The economic burden of tobacco consumption over the last 10 years (2001–2010) in the KSA was 20.5 billion US dollars (based on 2011 prices). Anti-tobacco measures in KSA have been reinforced by the enactment of anti-tobacco laws and collaboration among different government agencies and ministries.Conclusion: If effective tobacco control strategies are not enacted, serious consequences, increasing premature mortality rates among them, will continue to threaten the KSA.

Background: Epidemiological evidence shows that cancer and diabetes are major causes of death in the world. Type2 diabetes increases the risk of cancer-specific mortality. This review relates diabetic therapies, diabetes and cancer.Method: All published papers in this field were searched, looking into such databases as Science Direct, ISI Web of Knowledge, PubMed and Scopus.Results: In cancer patients, metformin improves patient outcome and reduces cancer risk. Sulfonylureas may increase risk of cancer, but decreased risk of cancer is associated with thiazolidinediones in type2 diabetic subjects. Metformin lowers circulating insulin and it may be important for treatment of hyperinsulinemia-associated cancers, such as colon and breast cancer.Conclusion: However, laboratory investigations and large-scale population based studies are required for further in-vestigation of association of cancer-preventive, anti-cancer and cancer-mortality of noninsulin antidiabetics.

Background: The ratio of CD4+/CD8+has been used as a clinically index to evaluate patients’ immunity. Numerous researchers have studied CD4+/CD8+ratio in pulmonary tuberculosis (PTB) patients. However, the change of CD4+/CD8+ratio remains controversial. We present a meta-analysis of 15 case-control studies to identify the change of CD4+/CD8+ratio in PTB patients.Methods: We assessed heterogeneity of effect estimates within each group using I2 test. Subgroup analysis was per-formed to explore the potential source of heterogeneity. To investigate further the potential publication bias, we visu-ally examined the funnel plots. For robustness of results, we performed sensitivity analysis by removing studies. Data entry and analyses were carried out with RevMan 5.2 (The Nordic Cochrane Centre).Results: Twelve peripheral blood studies were categorized into two subgroups. Eight studies presented a significant decrease of CD4+/CD8+ratio in PTB cases compared to healthy subjects (SMD: -0.45; 95% CI -0.65–-0.25; I2=7%). Other four studies researched on the newly diagnosed patients presented a more seriously and significantly de-crease (SMD: -2.17; 95% CI -2.61–-1.74; I2=37%). The pooled analysis of bronchoalveolar lavage fluid (BALF) studies showed a significant increase of CD4+/CD8+ratio using Flow Cytometry (FCM) (SMD: 4.75; 95% CI 3.44–6.05; I2=0%).Conclusion: The present meta-analysis indicated that there was a synthetic evidence for the reduced CD4+/CD8+ratio in peripheral blood of PTB patients, especially newly diagnosed cases. However, the CD4+/CD8+ratio in BALF was increased using method of FCM.

Background: Georgia is a country with a Human Development Index (HDI) score of 0.733. Significant deterioration in socio-economic conditions in the 1990s caused serious health problems in the population including oral health. Since then, there has not been an epidemiological survey of dental diseases among the adult population in Georgia.Methods: The pathfinder survey- cluster- stratified method derived by WHO was used for sampling. Overall, 2370 adults including 1289 women and 1081 men in nine regions of Georgia including the residents of a city, town and village in each region and the capital, Tbilisi, were examined. Four age groups were investigated including: I- (20-34), II- (35-44), III- (45-64), IV- (65-74).Results: Unhealthy periodontal tissues were observed in 66.9% of men and in 57.5% of women. Bleeding on probing occurred in 44.9% of men and 37.2% of women, with periodontal pockets in 46.8% of men and 40.6% of women. Inflammation was seen in 61.2% of men and 54.8% of women. Healthy periodontal tissues were most common (59.2%) in the first age group (20-34); periodontal pockets (0-3mm) were least common (9.8%) at this age. Pockets of³4-5mm depth were observed mostly in the 3rd (9.4%) and 4th (10%) age groups.Conclusion: The high prevalence of periodontal diseases in the adult population of Georgia is explained by a low socio-economic status and low medical education background with a negative attitude towards oral hygiene skills and low levels of dental service accessibility.

Background: The current study aimed to detect the presence of Helicobacter pylori in some water systems in Egypt as well as in blood samples of patients suffering from stomach ulcers.Methods: Fifty-one water samples collected from some Egyptian governorates; Giza, Alexandria, Monofia, Beheira, Minya, Sohag, was subjected to physical and chemical analysis. Urease gene ureC, a highly specific sequence in H. pylori DNA was tracked in tested water samples and then in blood samples of patients’ resident in areas with infected water supply using PCR technique. Data were all fed to the computer using IBM SPSS software package version 20.0. Qualitative data were described using number and percent. Comparison between different groups regarding categorical variables was tested using Chisquare test.Results: Two samples, belonging to Abu El Matamir-Beheira, and Sidi Bishr-Alexandria, showed positive results for presence of H. pylori. These two samples gave a positive result for the second time, on applying PCR technique for the cultures isolated under microaeroplilic conditions. Blood samples (173) were withdrawn from individuals living in the two areas with infected water supply. As diagnosed by ELISA, positive tests for H. pylori were recorded in 33.3% and 33.8% of patients suffering from ulcers in Abu El Matamir-Beheira, and Sidi Bishr-Alexandria, respectively.Conclusion: In developing countries such as Egypt, there is a big possibility for H. pylori to be transmitted via drinking water, hence, causing an epidemic infection, particularly in dense populated areas.

Background: Hyperglycemia and gestational diabetes mellitus are complications of pregnancy. Both mothers and newborns are typically at increased risk for complications. This study sought to determine effect of zinc supplementation on serum glucose levels, insulin resistance, energy and macronutrients intakes in pregnant women with impaired glucose tolerance.Methods: In this clinical trial 44 pregnant women with impaired glucose tolerance, from December 2012 –April 2013 were randomly divided into zinc (n=22) and placebo (n=22) groups and recived 30mg/day zinc gluconate and (n=22), and placebo for eight consecutive weeks respectively. Dietary food intake was estimated from 3-days diet records. Se-rum levels of zinc, fasting blood sugar, and insulin were measured by conventional methods. Also homeostatic model assessment of insulin resistance was calculated.Results: Serumlevels of fasting blood sugar, insulin and homeostatic model assessment of insulin resistance slightly decreased in zinc group, but these changes were not statistically significant. Serum zinc levels (P=0.012), energy (P=0.037), protein (P=0.019) and fat (P=0.017) intakes increased statistically significant in the zinc group after intervention but not in the placebo group.Conclusion: Oral supplementation with zinc could be effective in increasing serum zinc levels and energy intake with no effects on fasting blood sugar, homeostatic model assessment of insulin resistance and insulin levels.

Background: Malnutrition and dehydration are two most common types of ailments residents of nursing homes (NH) prone to. It is very important to assess these problems because they can predispose the residents to severe ill-nesses. The aim of this study was to gather information on nutritional status and its associated risk factors in elderly residents of NHs in Tehran, Iran.Methods: From 16 NHs in Tehran, 263 residents were randomly selected. Data were collected via questionnaires, including demographic characteristics, past medical history, present health problems and daily routines. The MNA questionnaire was used to gather information regarding their nutritional status.Results: The present study showed that 10.3% of the elderly residents in nursing homes were malnourished.66.4% of males and 70.8% of females were at risk of malnutrition. Multivariate analysis showed that after adjusting for con-founders the following elderly-related factors were the independent risk factors of malnutrition: consuming half or less than of the food (OR=8.0, 95%CI=3.7-17.7), having no teeth or good prosthesis (OR=1.7, 95%CI=1.1-2.7), diabetes (OR=1.6, 95%CI=1.1-2.4), smoking (OR=0.6, 95%CI=0.3-1.2), studying (OR=0.4 95%CI=0.2-0.9) and praying in their free time (OR=1.8 95%CI=1.2-2.6).Conclusion: The subjects’ health-related factors and their free-time activities and nutritional behavior are the most important factors associated with poor nutrition among elderly residents of NHs; however, further investigation is needed to clarify the role of other factors in maintaining a suitable nutritional plan for them.

Background: Diabetes is a global health problem in the world. Probiotic food has anti-diabetic property. The aim of this trial was to determine the effect of probiotic fermented milk (kefir) on glucose and lipid profile control in patients with type 2 diabetes mellitus.Methods: This randomized double-blind placebo-controlled clinical trial was conducted on 60 diabetic patients aged 35 to 65 years. Patients were randomly and equally (n=30) assigned to consume either probiotic fermented milk (kefir) or conventional fermented milk (dough) for 8 weeks. Probiotic group consumed 600 ml/day probiotic fermented milk containing Lactobacillus casei, Lactobacillus acidophilus and Bifidobacteria and control group consumed 600 ml/day conventional fermented milk. Blood samples tested for fasting blood glucose, HbA1C, triglyceride (TG), total cholesterol, HDL-C and LDL-C at the baseline and end of the study.Results: The comparison of fasting blood glucose between two groups after intervention was statistically significant (P=0.01). After intervention, reduced HbA1C compared with the baseline value in probiotic fermented milk group was statistically significant (P=0.001), also the HbA1C level significantly decreased in probiotic group in comparison with control group (P=0.02) adjusting for serum levels of glucose, baseline values of HbA1c and energy intake accord-ing to ANCOVA model. Serum triglyceride, total cholesterol, LDL-cholesterol and HDL- cholesterol levels were not shown significant differences between and within the groups after intervention.Conclusion: Probiotic fermented milk can be useful as a complementary or adjuvant therapy in the treatment of diabetes.

Background: This study was conducted with the aim of determining surface water contamination with cysts of Entamoeba histolytica using PCR in Rasht City, Northern Iran.Methods: In this cross-sectional study, 49 water samples including 18 rivers and 6 wetlands were collected from different regions near the city of Rasht in autumn of 2012. After filtration using 0.22 mm nitrate cellulose membrane filters, the samples were examined using microscope and PCR method.Results: In microscopic examination, four samples of the 49 samples were positive for cysts of E. (histolytica / dispar / muschkovskii). By using PCR method and molecular analysis, one sample was positive for E. histolytica.Conclusion: In the molecular analysis, contamination by E. histolytica was proved in the waters of Rasht City. Further investigations including more samples and necessary preparations must be applied to prevent contamination.

Background: Food security is a multi-dimensional phenomenon. The objective of this study was to identify and prioritize major indices for determining food insecurity in Iran.Methods: Descriptive study using the Delphi method was conducted through an email-delivered questionnaire. Forty-three senior experts at national or provincial level were selected based on their work experience and educational back-ground through study panel consultation and snowballing from Tehran and other cities of Iran. During two rounds of Delphi, participants were asked to identify priority indicators for food security at provincial level in Iran.Results: Sixty five percent of Delphi panel participated in the first round and eighty-nine percent of them participated in the second round of Delphi. Initially, 243 indices were identified through review of literature; after excluding indictors, which was not available or measurable at provincial level in Iran, 103 indictors remained. The results of study showed that experts identified "percentage of individuals receiving less than 70% of daily energy requirement" with a median score of 90, as the most influential index for determining food insecurity. "Food expenses as a proportion of the overall expenses of the family", "per capita of dietary energy supply", and "provision of micro-nutrient supply requirement per capita" with median of 80 were in the second rank of food security priority indicators.Conclusion: Out of 243 identified indicators for food security, 38 indicators were selected as the most priority indicators for food security at provincial level in Iran.

Background: Anxiety is one of the most common reactions that parents show while understanding their children’s intellectual disability due to Down syndrome. Anxiety leads parents not to develop appropriate relations with their children, subsequently their psychological health are at risk. The present study was aimed to determine the effect of problem-focused coping strategy training on psychological symptoms of mothers with Down child.Methods: This was an experimental study with pretest and posttest design with case and control group. Sixty-four mothers were selected randomly from Iranian Down Syndrome Charity Society. They completed Symptoms Checklist-90-Revised (SCL-90-R). They were assigned to experimental and control groups in equal. Experimental group participated in 12 training sessions (once a week; 60 minutes for each session) and received problem-focused coping strategy program, but control group did not. After 12th session, all subjects completed SCL-90-R again. Analysis of covariance was used for analyzing the data.Results: There was a significant difference (P<0.01) between experimental and control group according to psychological symptoms and its components (phobia, depression, paranoid thoughts, psychosis, somatic complaints, interpersonal sensitivity, obsession-compulsion, anxiety and aggression) after participation in intervention sessions.Conclusion: There was a significant decrease in psychological symptoms, phobia, depression, paranoid thoughts, psychosis, somatic complaints, interpersonal sensitivity, obsession-compulsion, anxiety and aggression of experimental group. Our findings showed that problem-focused coping strategy-training program led to improve family’s perception towards the child and subsequently promote of mental health of mothers with Down children.

Background: The MIRU-VNTR polymorphism and katG463 mutation are used to genotype the mycobacterium tuberculosis, but the correlation between them and INH-resistance were unknown. This study was aimed to explore whether ETRE polymorphism and katG463 mutation could predict the INH-resistance, and the relationship between ETRE polymorphism and katG463 mutation.Methods: The ETRE, katG463 mutation and drug resistance information of 109 M. tuberculosis strains were collected from online public database. We constructed the predictive diagnostic tool of ETRE polymorphism and katG463 mutation. Chi-square test was used to analyze the relationship between ETRE polymorphism, katG463 mutation and INH-resistance. ROC curve analysis and Z-test were used to evaluate the predictive ability of ETRE and katG463. The relationship between ETRE polymorphism and katG463 mutation was analyzed with Spearman correlation analysis.Results: The mutation rate of katG463 was 27.50%, and the h value of ETRE polymorphism was 0.67. katG463 mutation was associated with INH resistance (OR=3.72). The INH drug resistance rate in VNTR³5 group was 3.43 times higher than that in VNTR£3 group (c2=24.77, P<0.01), and there was no significant difference of INH resistance between the VNTR=4 group and VNTR£3 group. The areas under the ROC curve of two loci prediction diagnostic tools were 0.64 and 0.70 respectively. The katG463 mutation was significantly related to the ETRE poly-morphismr (r=0.79, P<0.01).Conclusion: Both katG463 mutation and the ETRE polymorphism can predict the INH-resistance of tuberculosis. The katG463 mutation was associated with ETRE VNTR polymorphism.

Background: There is a shift worldwide towards a diet that is high in processed foods and low in fiber, leading to a corresponding increase in degenerative diseases. These diseases are interrelated with lifestyles and especially with diets. The aim of this study was to investigate the eating habit differences between two generations of mothers and daughters and their tendency towards modern foods.Methods: In this cross-sectional survey, the data were gathered using structured questionnaires. The sample of the study includes 618 women in Shiraz City (309 mothers and 309 daughters) selected through stratified random sampling. Data analysis was carried out using the SPSS software.Results: In the mothers’ generation, around 80% showed a traditional nutritional pattern while in the young generation more than 50% had a modern or close to modern pattern of nutrition (P£0.05). The findings confirmed a significant difference in dietary habits among the two generations. For both generations, nutrition pattern was significantly different in terms of social class, weight control, education, using mass communication, and physical activities (P£0.05).Conclusion: Iran is currently experiencing a nutrition transition. The current inappropriate habits in the lifestyles of the girls’ in Shiraz are a health threat for them, and it will increase the risk of non-communicable diseases. Therefore, policy makers have to set new agenda to increase the nutritional knowledge of the population.

Genitourinary tuberculosis (GUTB) is difficult to diagnose in the earlier stage owing to the non-specific symptoms. Usually, renal tuberculous involvement is unilateral and the imaging finding is renal calcification, but associated calcifications of bilateral ureter and bladder are rare. We report a 66-year-old man who presented with diffuse calcification of the urinary system (including bilateral pelvicalyceal system, both ureters and bladder) and disseminated miliary tuberculosis due to GUTB. He had been misdiagnosed with urinary tract infection and urinary lithiasis for two years before the diagnosis of GUTB was confirmed by microbiological examination of the urine. This case highlights the importance of maintaining a high index of clinical suspicion for GUTB.

Background: Human fasciolosis is deemed as an emerging/re-emerging infection, hence making it an important human parasitic disease. In contrast to northern parts of Iran, human cases of fasciolosis in southern Iran are rare and sporadic. We report a sporadic case of fasciolosis in southern Iran (Fars Province) who presented with prolonged fever. Our report could suggest that there might be new foci emerging in the region, which indicates the need for further investigations.

Mirtazapine is a new antidepressant that can increase noradrenergic and serotonergic neurotransmission. It is also a postsynaptic antagonist of 5-HT2 and 5-HT3. In addition, it has only a weak affinity for 5-HT1 receptors and has very weak muscarinic anticholinergic and histamine (H1) antagonist properties. We report a case of hypertensive urgency that ensued after a patient took a single low dose of mirtazapine.

Dear Editor-in-Chief: After abandoned from other than the few African countries, the Ebola outbreak is shifted to pandemic and has been impact on global economy (1). Global efforts have been jointly urged to combat with this emergency crisis, but most of the developing countries are far behind the capacity to battle the outbreak with their weak health systems. Unfortunately, governances are still not grave for this horrific crisis and no effective network has been established. If we really wish for effective action to combat this crisis, all the governments and development partners should develop strategies to respond it’s monetary and supply assurances. In addition, upgraded physical facilities, skilled health manpower, effectively established emergency response network and sufficient re-sources are the crucial constraints for developing countries.

Dear Editor-in-Chief: Hospital gradation systems are used to examine the performance of hospitals to promote the efficient use of medical resources (1). Patient-perceived service quality may differ for differing grades of medical institutions under gradation sys-tem, which has been rarely reported. The aim of the present study was to explore the relation between the hospital gradation system and patient perceptions under Taiwanese hospital gradation system. The specialty of dentistry was investigated due to dental care being significantly different from other medical services (2). Dental care is more personal, intimate, and lasting contact with the patient (3). Nevertheless, quality assessment of dental service remains relatively primitive (4).

Dear Editor -in-Chief: The most commonly used definitions of intellectual disability (ID) have been promulgated by the American Association of Intellectual Develop-mental Disorder (AAIDD). The most recent version stated that it is a disability: "characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18" (1). The quality of family life is fundamental to the wellbeing of children. Family relationships in general and the parent-child relationship in particular have a pervasive influence on the psychological, physical, social and economic wellbeing of children (2).

Dear editor-in-Chief: Problems of surgical care have become a main cause of mortality and morbidity throughout the world. In 2004, the total amount of important surgery was an estimated almost one operation annually for every 25 human beings alive (1, 2). This is a large number with significant results for public health (2). Even though noticeable improvements in surgical safety knowledge, at least half of the events happen during surgical care (3, 4).

Dear Editor-in-Chief: One way to improve the quality of hospital services is accreditation and, as a strategy for improving services, many countries have launched their national accreditation system (1, 2). Accreditation, as an independent voluntary program, was established in 1917 in the United States by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for evaluating hospitals. In 1998, its international branch called the Joint Commission International (JCI), aimed at the development of a set of accreditation standards, began. Currently, this program is the most comprehensive accreditation one in the world (3).

Dear Editor-in-Chief: China was a high endemic area of hepatitis B virus infection, it is estimated that around 100 mil-lion people (about 10% of the Chinese population) are chronically infected (1). Health services and policy research is an emerging interdisciplinary field, which examines the interactions between access, quality of care, and resource utilization that occur within a variety of delivery system models providing medical care (2). Between Au-gust and December 2012, we conducted the survey of patients with HBV-related diseases in 3 county hospitals from 3 model regions in Jiangsu Province, China. Time phasing continuous sampling method was used, and 430 patients were observed. In the study, we estimated health care services utilized for outpatient care, hospitalization and related payments.